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Sumii K, Ichimura T, Nakagawa H, Kitamura A. Transesophageal Echocardiographic Evaluation of Coronary Blood Flow and the Initial Flap Assisting in the Surgical Decision-Making: A Case of Acute Type A Aortic Dissection. Cureus 2024; 16:e61872. [PMID: 38975408 PMCID: PMC11227659 DOI: 10.7759/cureus.61872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2024] [Indexed: 07/09/2024] Open
Abstract
Acute aortic dissection is a life-threatening condition. Myocardial ischemia associated with dissection occurs due to direct extension into the coronary artery or indirect involvement of the coronary ostia secondary to the dissection flap. Thus, the surgical procedure may require coronary reconstruction, in addition to aortic replacement. We experienced a case in which coronary artery reconstruction could be avoided because intraoperative transesophageal echocardiography showed that the aortic flap did not obstruct the right coronary artery in systole, and pulsed Doppler imaging indicated that there was sufficient coronary blood flow. This case shows that it is critical to establish a correct and early diagnosis and to proceed with the appropriate treatment for patients with myocardial ischemia.
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Affiliation(s)
- Keisuke Sumii
- Anesthesiology, Saitama International Medical Center, Saitama Medical University, Saitama, JPN
| | - Takuya Ichimura
- Anesthesiology, Saitama International Medical Center, Saitama Medical University, Saitama, JPN
| | - Hideyuki Nakagawa
- Anesthesiology, Saitama International Medical Center, Saitama Medical University, Saitama, JPN
| | - Akira Kitamura
- Anesthesiology, Saitama International Medical Center, Saitama Medical University, Saitama, JPN
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2
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Matsumura H, Yashima F, Shimoji K. Spontaneous kissing stent for total occlusion of the left main trunk complicated by Stanford Type A aortic dissection. Eur Heart J 2024; 45:1179. [PMID: 38103212 DOI: 10.1093/eurheartj/ehad830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Affiliation(s)
- Hidenari Matsumura
- Department of Cardiology, Saiseikai Utsunomiya Hospital, 911-1 Takebayashi-cho, Utsunomiya, Tochigi, Japan
| | - Fumiaki Yashima
- Department of Cardiology, Saiseikai Utsunomiya Hospital, 911-1 Takebayashi-cho, Utsunomiya, Tochigi, Japan
| | - Kenichiro Shimoji
- Department of Cardiology, Saiseikai Utsunomiya Hospital, 911-1 Takebayashi-cho, Utsunomiya, Tochigi, Japan
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3
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Hashimoto O, Saito Y, Sasaki H, Yumoto K, Oshima S, Tobaru T, Kanda J, Sakai Y, Yasuda S. Treatment strategies and in-hospital mortality in patients with type A acute aortic dissection and coronary artery involvement. J Thorac Cardiovasc Surg 2024; 167:596-601.e3. [PMID: 35459537 DOI: 10.1016/j.jtcvs.2022.03.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Type A acute aortic dissection (AAD), especially that with coronary artery involvement and malperfusion, is a life-threatening disease. In the present study we aimed to investigate the association of surgical treatment and percutaneous coronary intervention (PCI) with in-hospital mortality in patients with type A AAD and coronary artery involvement. METHODS This retrospective multicenter registry in Japan included 225 patients with type A AAD and coronary artery involvement. Treatment strategies including surgical treatment and/or PCI were left to treating physicians. The primary end point was in-hospital death. RESULTS Of 225 patients, dissection extended into the right and left coronary arteries and both in 115 (51.1%), 105 (46.7%), and 5 (2.2%), respectively. Overall, 94 (41.8%) patients died during the hospitalization. Coronary angiography was performed in 53 (23.6%) patients, among whom 39 (73.6%) underwent PCI. Surgical repair was performed in 188 (83.6%) patients. In patients who received neither procedure, 33 of 35 (94.3%) died during the hospitalization. PCI was performed as a bridge to surgical repair in 37 of 39 (94.9%) patients, and in-hospital mortality of patients who underwent PCI and surgical procedures was 24.3%. Multivariable analysis identified PCI and surgical procedures as factors associated with lower in-hospital mortality rates. CONCLUSIONS Coronary artery involvement in type A AAD was associated with high in-hospital mortality of more than 40% in the current era. An early reperfusion strategy with PCI as a bridge to surgical repair might improve clinical outcomes in this fatal condition.
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Affiliation(s)
- Osamu Hashimoto
- Department of Cardiology, Chiba Emergency Medical Center, Chiba, Japan
| | - Yuichi Saito
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
| | - Haruka Sasaki
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan; Department of Cardiology, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Keita Yumoto
- Department of Cardiovascular Surgery, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Susumu Oshima
- Department of Aortic Surgery, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Tetsuya Tobaru
- Department of Cardiology, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Junji Kanda
- Department of Cardiovascular Medicine, Asahi General Hospital, Asahi, Japan
| | - Yoshiaki Sakai
- Department of Cardiology, Chiba Emergency Medical Center, Chiba, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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4
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Adiarto S, Kurnianingsih N, Prasetya I, Nugroho FW, Uberoi R. Successful Primary PCI in Stanford Type A Aortic Dissection Complicated by Inferior ST-Elevation Myocardial Infarction: A Case in a Facility with No Surgical Backup. Int J Angiol 2024; 33:62-65. [PMID: 38352639 PMCID: PMC10861288 DOI: 10.1055/s-0041-1735205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Mortality of type A aortic dissection (TAAD) complicated with coronary malperfusion syndrome is very high even when emergency surgery is performed. Several reports suggested that primary percutaneous coronary intervention (PPCI) followed by immediate corrective surgery may reduce mortality. In many countries, immediate transfer to an aortic surgery center may not be possible. We report a case of TAAD complicated by coronary malperfusion successfully treated with PPCI followed by elective corrective surgery. A 48-year-old man was referred to emergency department with acute inferior ST-elevation myocardial infarction (STEMI) and underwent PPCI. During the procedure, we realized that the cause of STEMI was TAAD. We decided to continue because the patient experienced seizures and bradycardia. Subsequently, echocardiography and computed tomography confirmed the dissection. The patient was discharged and referred to the National Cardiovascular Center where he underwent successful elective surgery. In this patient, immediate revascularization was lifesaving and served as a bridging procedure before surgical correction.
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Affiliation(s)
- Suko Adiarto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia/Harapan Kita National Cardiovascular Center, West Jakarta, Jakarta, Indonesia
| | - Novi Kurnianingsih
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Brawijaya University/Dr. Saiful Anwar Hospital, Malang, East Java, Indonesia
| | - Indra Prasetya
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Brawijaya University/Dr. Saiful Anwar Hospital, Malang, East Java, Indonesia
| | - Faris W. Nugroho
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Brawijaya University/Dr. Saiful Anwar Hospital, Malang, East Java, Indonesia
| | - Raman Uberoi
- Department of Radiology, John Radcliffe Hospital, Headington, Oxford, United Kingdom
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5
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Minamidate N, Wakisaka H, Hachiro K, Miyashita F, Morimoto M, Kondo Y, Enomoto M, Takashima N, Suzuki T. Is central repair with coronary artery bypass grafting enough for multi-organ malperfusion in acute type A aortic dissection with coronary malperfusion? Asian J Surg 2023; 46:5449-5453. [PMID: 37311670 DOI: 10.1016/j.asjsur.2023.05.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/22/2023] [Accepted: 05/25/2023] [Indexed: 06/15/2023] Open
Abstract
OBJECTIVES Acute type A aortic dissection with coronary malperfusion syndrome is rare but associated with high mortality. Multi-organ malperfusion is an independent predictor of acute type A aortic dissection. Coronary malperfusion requires treatment, but it is not feasible to treat all malperfusions. The adequacy of "central repair and coronary artery bypass grafting" for patients with coronary and other organ malperfusion is unknown. METHODS Of the 299 patients who underwent surgery between 2008 and 2018, 21 patients with coronary malperfusion, who received cental repair with coronary artery graft bypass, were analyzed retrospectively. They were divided; into Group M (n = 13, coronary and other organ malperfusion) and Group O (n = 8, coronary malperfusion only). The patient background, surgical content, details of malperfusion, surgical mortality and morbidity, and long-term outcome were compared. RESULTS There was no difference in operation time (205 ± 30 vs. 266 ± 88, p = 0.49), but the time from arrival to circulatory arrest tended to be shorter in Group M (81 vs. 134, p = 0.05). Among Group M, cerebral malperfusion was the most common at 92%. Two of the three cases with mesenteric malperfusion died. The mortality of Group M and Group O was 13% and 15% (P = 0.85), respectively. There was no difference in long-term mortality (p = 0.62). CONCLUSIONS Central repair and coronary artery bypass grafting is a sufficiently acceptable treatment for patients with acute type A aortic dissection and multi-organ malperfusion, including coronary malperfusion.
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Affiliation(s)
- Naoshi Minamidate
- Department of Cardiovascular Surgery, Shiga University of Medical Science, Shiga, Japan.
| | - Hodaka Wakisaka
- Department of Cardiovascular Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Kohei Hachiro
- Department of Cardiovascular Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Fumihiro Miyashita
- Department of Cardiovascular Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Masanori Morimoto
- Department of Cardiovascular Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Yasuo Kondo
- Department of Cardiovascular Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Masahide Enomoto
- Department of Cardiovascular Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Noriyuki Takashima
- Department of Cardiovascular Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Tomoaki Suzuki
- Department of Cardiovascular Surgery, Shiga University of Medical Science, Shiga, Japan
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6
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Kirigaya J, Iwahashi N, Abe T, Gohbara M, Hanajima Y, Horii M, Okada K, Matsuzawa Y, Yasuda S, Kosuge M, Ebina T, Takeuchi I, Uchida K, Tamura K, Hibi K. Clinical Usefulness of Echocardiographic Measurement of Proximal Aortic Diameter in Early Differentiation Between Type A Acute Aortic Dissection and ST-Segment-Elevation Myocardial Infarction. J Am Heart Assoc 2023; 12:e029506. [PMID: 37850479 PMCID: PMC10727378 DOI: 10.1161/jaha.123.029506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 09/13/2023] [Indexed: 10/19/2023]
Abstract
Background Contradictions between management modalities of type A acute aortic dissection (TAAAD) and ST-elevation-myocardial infarction (STEMI) may result in clinical catastrophe. Therefore, we aimed to explore which 2-dimensional echocardiography (2DE) findings are optimal for differentiating TAAAD from STEMI. Methods and Results This study included 340 patients with STEMI and 340 patients with TAAAD who underwent 2DE in the emergency department between 2012 and 2021. The proximal ascending aorta (PAA) diameter and other echocardiographic parameters were analyzed. PAA diameters were measured at 4 levels in the parasternal view: Valsalva, the sinotubular junction (STJ), the PAA at 1 cm above the STJ, and the PAA at 2 cm above the STJ. Receiver-operating characteristic curve analysis showed that Valsalva, STJ, PAA at 1 cm above the STJ, and PAA at 2 cm above the STJ were significant predictors of TAAAD (areas under the curve: 0.777, 0.924, 0.965, and 0.975, respectively; P<0.001) with the respective cutoff values of 39.4, 38.5, 39.8, and 41.2 mm. Multivariable analysis suggested that all 2DE parameters were significant predictors of TAAAD. Among the 2DE parameters examined, the incorporation of PAA at 2 cm above the STJ to clinical indicators exhibited the most significant diagnostic capability (C-statistics, 0.97; net reclassification improvement, 1.81; integrated discrimination improvement, 0.61). When only TAAAD with coronary malperfusion and STEMI were analyzed, the diagnostic utility of PAA at 1 cm above the STJ was evident (C-statistics, 0.99; net reclassification improvement, 1.79; integrated discrimination improvement, 0.67), with PAA at 2 cm above the STJ ranking second in diagnostic significance (C-statistics, 0.99; net reclassification improvement, 1.12; integrated discrimination improvement, 0.66). Conclusions PAA measurements were the most beneficial for diagnosing TAAAD in all 2DE findings and TAAAD from STEMI.
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Affiliation(s)
- Jin Kirigaya
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Noriaki Iwahashi
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Takeru Abe
- Advanced Critical Care and Emergency CenterYokohama City University Medical CenterYokohamaJapan
| | - Masaomi Gohbara
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Yohei Hanajima
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Mutsuo Horii
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Kozo Okada
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Yasushi Matsuzawa
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Shota Yasuda
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Masami Kosuge
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Toshiaki Ebina
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Ichiro Takeuchi
- Advanced Critical Care and Emergency CenterYokohama City University Medical CenterYokohamaJapan
| | - Keiji Uchida
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal MedicineYokohama City University Graduate School of MedicineYokohamaJapan
| | - Kiyoshi Hibi
- Division of CardiologyYokohama City University Medical CenterYokohamaJapan
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7
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Lasa-Berasain P, Salas PR, Azparren EE, Sanz ER. Myocardial infarction and haemorrhagic stroke as a rare presentation of acute aortic dissection: a fatal case report. Eur Heart J Case Rep 2023; 7:ytad529. [PMID: 37954566 PMCID: PMC10635585 DOI: 10.1093/ehjcr/ytad529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 10/11/2023] [Accepted: 10/20/2023] [Indexed: 11/14/2023]
Abstract
Background Type A acute aortic dissection (AAD) is an extremely severe condition, having a high risk of mortality. Initial diagnosis can be deceptive, especially in patients with other confounding presentations. Case summary We present the case of a 60-year-old male with a history of endovascular aortic repair for abdominal aortic dissection, in whom a diagnosis of AAD was made, but almost missed, after he presented with stroke signs and left coronary myocardial infarction. Thorough clinical evaluation and point-of-care ultrasound (POCUS) were fundamental to the diagnosis of the underlying condition, which showed the intimal flap in the ascending aorta, aortic insufficiency, and a dissected left common carotid artery. The diagnosis was confirmed with a head and thoracic computed tomography scan, which also showed bilateral haemorrhagic strokes. Treatment options can be limited in patients with AAD with associated complications. After a careful multidisciplinary evaluation, life-sustaining therapy was withdrawn and the patient passed away. Discussion Our case depicts the diagnosis challenge presented by patients with AAD. We emphasize the importance of clinical suspicion and POCUS examination for the diagnosis of the underlying condition, as it is frequently missed during first evaluation. We discuss the available literature regarding the prevalence and described mechanisms by which AAD can associate occlusion myocardial infarction, which more commonly involves the right coronary artery, as well as haemorrhagic stroke. We briefly mention management options, which are limited and controversial.
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Affiliation(s)
- Pablo Lasa-Berasain
- Department of Critical Care Medicine, Navarre University Hospital, Irunlarrea 3, 31008, Pamplona, Navarre, Spain
| | - Pablo Raposo Salas
- Department of Cardiology, Navarre University Hospital, Irunlarrea 3, 31008, Pamplona, Navarre, Spain
| | - Edurne Erice Azparren
- Department of Critical Care Medicine, Navarre University Hospital, Irunlarrea 3, 31008, Pamplona, Navarre, Spain
| | - Eva Regidor Sanz
- Department of Critical Care Medicine, Navarre University Hospital, Irunlarrea 3, 31008, Pamplona, Navarre, Spain
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Ogino H, Iida O, Akutsu K, Chiba Y, Hayashi H, Ishibashi-Ueda H, Kaji S, Kato M, Komori K, Matsuda H, Minatoya K, Morisaki H, Ohki T, Saiki Y, Shigematsu K, Shiiya N, Shimizu H, Azuma N, Higami H, Ichihashi S, Iwahashi T, Kamiya K, Katsumata T, Kawaharada N, Kinoshita Y, Matsumoto T, Miyamoto S, Morisaki T, Morota T, Nanto K, Nishibe T, Okada K, Orihashi K, Tazaki J, Toma M, Tsukube T, Uchida K, Ueda T, Usui A, Yamanaka K, Yamauchi H, Yoshioka K, Kimura T, Miyata T, Okita Y, Ono M, Ueda Y. JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection. Circ J 2023; 87:1410-1621. [PMID: 37661428 DOI: 10.1253/circj.cj-22-0794] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Koichi Akutsu
- Cardiovascular Medicine, Nippon Medical School Hospital
| | - Yoshiro Chiba
- Department of Cardiology, Mito Saiseikai General Hospital
| | | | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University
| | | | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine
| | | | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Hirooki Higami
- Department of Cardiology, Japanese Red Cross Otsu Hospital
| | | | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine
| | | | - Takuya Matsumoto
- Department of Vascular Surgery, International University of Health and Welfare
| | | | - Takayuki Morisaki
- Department of General Medicine, IMSUT Hospital, the Institute of Medical Science, the University of Tokyo
| | - Tetsuro Morota
- Department of Cardiovascular Surgery, Nippon Medical School Hospital
| | | | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kenji Okada
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | | | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Takuro Tsukube
- Department of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center
| | - Tatsuo Ueda
- Department of Radiology, Nippon Medical School
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kazuo Yamanaka
- Cardiovascular Center, Nara Prefecture General Medical Center
| | - Haruo Yamauchi
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Yutaka Okita
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
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9
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Yu J, Yu W, Zeng H, Gao J, Xiong J. Case report: Surgery combined with extracorporeal membrane oxygenation for a patient with type A aortic dissection complicated with myocardial infarction after percutaneous coronary intervention. Front Cardiovasc Med 2023; 10:1205373. [PMID: 37485265 PMCID: PMC10360360 DOI: 10.3389/fcvm.2023.1205373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/22/2023] [Indexed: 07/25/2023] Open
Abstract
Background Aortic dissection (AD) is a severe cardiovascular disease characterized by aortic rupture, aortic valve insufficiency, aortic branch lumen stenosis, and occlusion. Acute ST-segment elevation myocardial infarction may be the primary manifestation when aortic dissection affects the coronary artery, leading to delayed or missed diagnosis of aortic dissection, and preventing patients from receiving timely and comprehensive treatment. Simultaneous aortic repair and coronary artery bypass grafting surgery are controversial because of their high mortality rates. Personalized and optimal treatment plans for patients should be taken seriously based on their different conditions and treatment options. Case presentation A 42-year-old man who experienced 1 h of persistent precordialgia was admitted to a local second-level hospital for emergency treatment. Electrocardiogram (ECG) showed evidence of ST-segment elevation, and myocardial enzyme levels were CK-MB 18.35 ng/ml and troponin 0.42 ng/ml. The patient was treated for acute myocardial infarction (AMI) and urgently sent to the interventional catheter room. Coronary angiography showed stenosis of the starting part of the right coronary artery trunk. Thus, stent implantation was performed, and the stenosis section recovered patency; however, postoperative precordialgia was not alleviated. Computed tomography angiography (CTA) revealed a type A AD. The patient was immediately transferred to a higher-level hospital, underwent emergency surgery with cardiopulmonary bypass (CPB) ascending aorta replacement, SUN's procedure (total arch replacement and stented elephant trunk implantation), and simultaneous implantation of extracorporeal membrane oxygenation (ECMO), and regained consciousness within intensive care unit care. ECMO was discontinued when hemodynamics stabilized. The patient ultimately recovered well and was discharged. Conclusion This case demonstrated that precordialgia is not limited to myocardial infarction but may also be accompanied by aortic dissection. Percutaneous coronary intervention (PCI) can timely and effectively restore coronary artery perfusion, strive for the opportunity of aortic repair surgery, and can overcome pump failure caused by myocardial infarction, cardiopulmonary bypass, heart block time, and myocardial ischemia-reperfusion injury. Personalized treatment is crucial for patients with complex type A aortic dissection.
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Affiliation(s)
- Junjian Yu
- Department of Cardiac and Vascular Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Wenbo Yu
- The First Clinical Medical College of Gannan Medical University, Ganzhou, China
| | - Hui Zeng
- Department of Thoracic and Cardiac Surgery, Ningdu County People's Hospital, Ganzhou, China
| | - Jianfeng Gao
- The First Clinical Medical College of Gannan Medical University, Ganzhou, China
| | - Jianxian Xiong
- Department of Cardiac and Vascular Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
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10
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Tang T, Wang Z, Zhou W, Wang H, Zhang H, Sun A, Wei J, Sheng W, Zhang D. Management of chronic Stanford type A aortic dissection combined with Neri type C coronary occlusion: a case report and literature review. J Int Med Res 2023; 51:3000605231166505. [PMID: 37113047 PMCID: PMC10155008 DOI: 10.1177/03000605231166505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
While there are many reports on partial aortic root remodelling, it is rarely performed for chronic aortic dissection of the coronary artery. This case report describes a 71-year-old male patient with chronic aortic dissection who was admitted to hospital due to repeated palpitations and chest distress. He had a long-term occlusion of the right coronary artery and an abnormal origin of the left vertebral artery. A carefully planned surgical strategy was arranged for this patient, and the surgical experience is described and discussed herein. Briefly, the patient was treated by aortic root repair plus ascending aorta replacement plus Sun's procedure plus left vertebral artery graft implantation plus coronary artery bypass graft (right coronary artery to saphenous vein to innominate artery). At approximately 6 months following surgery, the patient had returned to normal living conditions without any reports of discomfort.
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Affiliation(s)
- Tiansheng Tang
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Wuhu, China
| | - Ziao Wang
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Wuhu, China
| | - Wei Zhou
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Wuhu, China
| | - Hai Wang
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Wuhu, China
| | - Hanjun Zhang
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Wuhu, China
| | - Ayu Sun
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Wuhu, China
| | - Jun Wei
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Wuhu, China
| | - Weiyong Sheng
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Wuhu, China
| | - Dafa Zhang
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Wuhu, China
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11
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Right versus left coronary artery involvement in patients with type A acute aortic dissection. Int J Cardiol 2023; 371:49-53. [PMID: 36257475 DOI: 10.1016/j.ijcard.2022.10.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/31/2022] [Accepted: 10/12/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Type A acute aortic dissection (AAD) complicated by coronary malperfusion is a life-threatening disease. In the present study, we compared the clinical characteristics and prognostic impact of treatment strategies including surgical treatment and percutaneous coronary intervention (PCI) in type A AAD patients with RCA and LCA involvement. METHODS This multicenter registry included 220 patients with type A AAD and either RCA or LCA involvement. Treatment strategies were left to treating physicians. The primary endpoint was in-hospital death. RESULTS Of 220 patients, 115 (52.3%) and 105 (47.7%) had RCA and LCA involvement. Patients with LCA involvement were more1 likely to present with Killip class IV on admission than those with RCA involvement. Coronary angiography was performed in 52 of 220 (23.6%) patients, among whom 39 (75.0%) underwent subsequent PCI. During the hospitalization, 93 (42.3%) patients died. Patients with LCA involvement had an increased risk of in-hospital mortality compared to those with RCA involvement (54.3% vs. 31.3%, p < 0.001). In patients with RCA involvement, multivariable analysis identified Killip class IV and no surgical treatment as predictors of in-hospital death, while PCI and surgical treatment were indicated as factors associated with lower in-hospital mortality in patients with LCA involvement. CONCLUSIONS The rates of RCA and LCA involvement were similar in type A AAD. Immediate PCI as a bridge to subsequent surgical treatment might improve survival in patients with type A AAD complicated by coronary malperfusion, especially in those with LCA involvement.
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12
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Shiiya N. Management of noncerebral malperfusion complicating acute type A dissection. Asian Cardiovasc Thorac Ann 2023; 31:26-31. [PMID: 35167355 DOI: 10.1177/02184923211069812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Vital organ malperfusion in acute type A aortic dissection is associated with worse outcomes, especially when multiple organ systems are involved, and when coronary or mesenteric malperfusion is present. To achieve the two goals of central aortic repair and adequate and timely reperfusion, mechanism and organ-specific strategy in the methods and sequence of repair should be considered. For dynamic aortic malperfusion, reperfusion can be quickly achieved by femoral artery perfusion, and the fenestrated frozen elephant trunk operation, in which the proximal end of device is secured to zone 1 or 2 and distal 1 or 2 supra-aortic vessels are preserved by fenestration of the fabric, seems optimal as a method of central aortic repair. For coronary malperfusion, percutaneous coronary intervention before central aortic repair may have a role. However, it should be kept in mind that the door-to-unloading time is also important to reduce the area of myocardial infarction, and retrograde cardioplegia is not distributed to most of the right ventricle, which can be critical when right coronary malperfusion is present. Static mesenteric malperfusion should be addressed first, and second-look laparotomy should not be hesitated after central aortic repair. The use of a hybrid operating room may be an optimal solution to achieve both goals.
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Affiliation(s)
- Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
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13
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Yang B. Does Acute Type A Aortic Dissection Equal Emergency Aortic Surgery? Ann Thorac Surg 2022; 115:1093-1094. [PMID: 36572061 DOI: 10.1016/j.athoracsur.2022.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 12/10/2022] [Indexed: 12/25/2022]
Affiliation(s)
- Bo Yang
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.
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14
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Qin W, Fan R, Wang J, Li J, Huang F, Chen X. Outcomes of surgical treatment on type A acute aortic dissection accompanied with coronary artery involvement. Front Surg 2022; 9:950264. [PMID: 36225217 PMCID: PMC9549406 DOI: 10.3389/fsurg.2022.950264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background Coronary artery (CA) involvement due to acute aortic dissection (AAD) is a catastrophic cardiovascular disease with high mortality. Two main surgery strategies, local coronary repair and coronary artery bypass grafting (CABG) can be applied to reestablish the blood flow in the aortic repair. This study was to evaluate the operative and long-term outcomes of type A AAD patients, who received aortic dissection repair plus CABG or local coronary repair. Method We reviewed our database and screened 148 type A AAD patients with CA involvement from January 2001 to December 2021. Local coronary repair or CABG was performed concomitantly on these enrolled patients. Results At the time of aortic repair, there were 58 patients with concomitant CABG (Group I) and 90 patients with local coronary repair (Group II). The basal characteristics of these two groups had no difference, except for acute myocardial ischemia (AMI) and CA involvement type. 45 patients with AMI in Group I, but none in Group II (P < 0.001). There was a higher frequency of type B and C lesions of CA involvement in Group I than that in Group II (P < 0.001). There was no difference in surgical procedures and complications, except for postoperative acute kidney injury (AKI) (34.5% vs. 8.9%, P < 0.001). Hospital mortality in Group I was higher than that in Group II, but without statistical difference (20.7% vs. 11.1%, P = 0.155). No significant difference was obtained in long-term survival rate between the two groups (82.5 ± 4.8% vs. 81.2 ± 6.9%, P = 0.19). Conclusion CABG and local coronary repair suits different types of CA involvement, and their effects on perioperative results and long-term survival for type A AAD patients with CA involvement are equal.
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Affiliation(s)
- Wei Qin
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Rui Fan
- School of Medicine, Southeast University, Nanjing, China
| | - Jiankai Wang
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jian Li
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Fuhua Huang
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- Correspondence: Fuhua Huang Xin Chen
| | - Xin Chen
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- School of Medicine, Southeast University, Nanjing, China
- Correspondence: Fuhua Huang Xin Chen
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15
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Minamidate N, Takashima N, Suzuki T. The impact of CK-MB elevation in patients with acute type A aortic dissection with coronary artery involvement. J Cardiothorac Surg 2022; 17:169. [PMID: 35794624 PMCID: PMC9260987 DOI: 10.1186/s13019-022-01924-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 05/28/2022] [Indexed: 11/11/2022] Open
Abstract
Background Acute type A aortic dissection (ATAAD) is a fatal disease and requires emergency surgery. In particular, it is known that mortality is high when a coronary artery is involved. However, the degree of myocardial damage of the coronary acute artery involvement (ACI) varies and may or may not increase creatine kinase muscle and brain isoenzyme (CK-MB). It is unknown how CK-MB elevation affects the surgical outcome. This study compared the surgical results between the two groups of ACI with or without CK-MB elevation. Methods Among 348 patients who underwent an emergency operation for acute type A aortic dissection, there were 28 (8.0%) patients complicated by ACI and underwent additional coronary artery bypass grafting. We divided 26 of those patients into two groups; the MI group ( with CK-MB elevation) and the NMI group (without CK-MB elevation), and compared both groups. Results Of the 26, sixteen were in the MI group, and ten were in the NMI group. The average CK-MB in the MI group was 225.5 IU/L, and that in the NMI group was 13.5 IU/L. The mean time from onset to surgery was 248 min in the MI group and 250 min in the NMI group. There was statistical significance in mortality ( 69% vs. 13%, p = 0.03). There was no significance in major complications (ICU days, reintubation, reoperation, pneumonia, sepsis). Conclusions Acute coronary artery involvement was associated with 8.0% of patients with ATAAD, and 62% had myocardial ischemia with CK-MB elevation. The MI group had significantly higher mortality than the NMI group. It is crucial for cases with suspected ACI to obtain coronary perfusion as soon as possible to prevent CK-MB from elevating.
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Affiliation(s)
- Naoshi Minamidate
- Department of Cardiovascular Surgery, Shiga University of Medical Science, Setatsukinowa, Otsu, Shiga, 520-2192, Japan
| | - Noriyuki Takashima
- Department of Cardiovascular Surgery, Shiga University of Medical Science, Setatsukinowa, Otsu, Shiga, 520-2192, Japan
| | - Tomoaki Suzuki
- Department of Cardiovascular Surgery, Shiga University of Medical Science, Setatsukinowa, Otsu, Shiga, 520-2192, Japan.
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16
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Zhang Q, Yang DD, Xu YF, Qiu YG, Zhang ZY. De Winter electrocardiogram pattern due to type A aortic dissection: a case report. BMC Cardiovasc Disord 2022; 22:150. [PMID: 35382768 PMCID: PMC8981714 DOI: 10.1186/s12872-022-02596-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/29/2022] [Indexed: 12/06/2022] Open
Abstract
Background De Winter electrocardiograph (ECG) pattern is an atypical presentation of acute myocardial infarction (AMI) due to severe stenosis of the left anterior descending (LAD). Complications of acute aortic dissection (AD) in the setting of acute myocardial infarction (AMI) with de Winter sign are relatively rare and physicians may easily miss the diagnosis of AD. We report a case of patient with acute chest pain and de Winter ECG pattern due to AD involving the left main coronary artery (LM), LAD and left circumflex artery (LCX). Case presentation A 57-year-old male patient was initially diagnosed with AMI and then the diagnosis of acute AD was supported by transthoracic echocardiograph (TTE). After two stents were implanted respectively into the proximal LM-LAD and LM-LCX, he recovered from cardiogenic shock. Two months later, the patient underwent the surgery of ascending aorta replacement. After the surgery, there was no obvious chest discomfort during follow-up. Conclusions When an ECG shows a “de Winter pattern”, we should also consider the possibility of AD which result in LAD occlusion. TTE is a useful tool in screening for AD. Further research is needed to prove that percutaneous coronary intervention (PCI) may be a useful treatment strategy in the case of AD leading to severe LAD occlusion and unstable hemodynamics when there’s no condition to perform aortic replacement surgery immediately. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02596-8.
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Affiliation(s)
- Qing Zhang
- Department of Neurology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), No. 54 Youdian Road, Shangcheng District, Hangzhou, 310006, Zhejiang, China
| | - Dong-Dong Yang
- Department of Emergency Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), No. 54 Youdian Road, Shangcheng District, Hangzhou, 310006, Zhejiang, China.
| | - Yi-Fei Xu
- Department of Cardiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), No. 54 Youdian Road, Shangcheng District, Hangzhou, 310006, Zhejiang, China
| | - Yuan-Gang Qiu
- Department of Cardiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), No. 54 Youdian Road, Shangcheng District, Hangzhou, 310006, Zhejiang, China
| | - Zhuo-Yi Zhang
- Department of Emergency Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), No. 54 Youdian Road, Shangcheng District, Hangzhou, 310006, Zhejiang, China
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17
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Sen G, Veitch A, Nabais S. Anterior STEMI complicating acute aortic syndrome: mechanistic insight and bridge to surgery with intravascular ultrasound-guided primary PCI. BMJ Case Rep 2022; 15:e248055. [PMID: 35260406 PMCID: PMC8905978 DOI: 10.1136/bcr-2021-248055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2022] [Indexed: 11/04/2022] Open
Abstract
Stanford type A acute aortic syndromes (AAS) can be complicated with acute coronary closure and ST segment elevation myocardial infarction (STEMI) leading to significant additional morbidity and mortality. The recommended treatment for type A AAS is emergency cardiac surgery. We present the case of a patient with intramural haematoma involving the ascending and descending aorta complicated with anterior wall STEMI after CT imaging. Coronary angiography and intravascular ultrasonography (IVUS) revealed the dissection spiralling into the media of the left main stem (LMS) and left anterior descending (LAD) coronary artery. In the setting of acute vessel closure and ongoing myocardial ischaemia primary percutaneous coronary intervention (PCI) was performed to the LMS, LAD and second diagonal branch prior to successful emergency cardiac surgery with an aortic-arch interposition graft. Emergency IVUS-guided stenting to relieve acute coronary occlusion in the context of aortic dissection can be performed in selected cases to safely bridge the patient for cardiac surgery.
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Affiliation(s)
- Gautam Sen
- Department of Cardiology, Salisbury NHS Foundation Trust, Salisbury, Wiltshire, UK
| | - Alice Veitch
- Department of Radiology, Salisbury NHS Foundation Trust, Salisbury, Wiltshire, UK
| | - Sergio Nabais
- Department of Cardiology, Salisbury NHS Foundation Trust, Salisbury, Wiltshire, UK
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18
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Jung JC, Park KH. Coronary artery disease in aortic aneurysm and dissection. Indian J Thorac Cardiovasc Surg 2021; 38:115-121. [PMID: 35463718 PMCID: PMC8980968 DOI: 10.1007/s12055-021-01265-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/17/2021] [Accepted: 08/23/2021] [Indexed: 11/30/2022] Open
Abstract
Coexisting coronary artery disease is a significant risk factor of untoward outcomes after surgical and endovascular aortic repair. This article reviewed the data, consensus, and remaining controversy about the diagnosis and management of coexisting coronary artery disease in the patients who require intervention for aortic aneurysm and dissection. It can be summarized as follows: (1) the current guidelines generally recommend the same diagnostic algorithm, including indications of coronary artery angiography, as one for non-surgical patients; (2) they also recommend the same indications of coronary revascularization; and (3) there are minor, but important, remaining issues regarding the details of management and surgical techniques most of which are still at the discretion of individual surgeons and institutions. Because it is not likely to get large-scale investigational data about these issues, the collection of individual experiences should be promoted in future scientific meetings to build up the consensus.
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Affiliation(s)
- Joon Chul Jung
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Bundang-gu, Seongnam-si, Gyeonggi-do 13620 Republic of Korea
| | - Kay-Hyun Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Bundang-gu, Seongnam-si, Gyeonggi-do 13620 Republic of Korea
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19
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Type A aortic dissection with left coronary malperfusion. Gen Thorac Cardiovasc Surg 2021; 70:178-180. [PMID: 34716879 DOI: 10.1007/s11748-021-01728-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Abstract
Left coronary artery malperfusion is a fatal complication of acute type A aortic dissection. However, effective treatment strategies have not yet been established. Herein, we report two cases of left coronary artery malperfusion successfully treated with different preoperative catheter interventions, followed by a central aortic repair. Preoperative coronary intervention ensuring the blood flow to the left coronary artery might be essential if a coronary angiogram was performed prior to the diagnosis and treatment.
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20
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Taguchi Y, Kubo S, Ikuta A, Osakada K, Takamatsu M, Takahashi K, Ohya M, Shimada T, Miura K, Murai R, Tada T, Tanaka H, Fuku Y, Goto T, Komiya T, Kadota K. Percutaneous coronary intervention for left main coronary artery malperfusion in acute type A aortic dissection. Cardiovasc Interv Ther 2021; 37:333-342. [PMID: 34255294 PMCID: PMC8926951 DOI: 10.1007/s12928-021-00793-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 07/02/2021] [Indexed: 01/16/2023]
Abstract
The clinical outcomes of patients undergoing percutaneous coronary intervention (PCI) for left main coronary artery (LMCA) malperfusion caused by acute type A aortic dissection (AAAD) remains largely unexplored. The aim of this study was to determine the clinical outcomes of patients undergoing PCI for LMCA malperfusion caused by AAAD. We examined nine consecutive patients undergoing PCI for LMCA malperfusion caused by AAAD between 1995 and 2020. The mean age was 55.4 ± 7.7 years. Eight patients presented cardiogenic shock, and five patients cardiopulmonary arrest. Two patients were diagnosed with AAAD before coronary angiography using computed tomography and transthoracic echocardiography, respectively, and in the other seven patients after coronary angiography using other modalities. Four patients underwent PCI on intra-aortic balloon pumping support, and four patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO) support, including one patient on both. PCI was successful in eight patients, with final thrombolysis in myocardial infarction grade 2 or 3. The four patients on VA-ECMO did not undergo aortic dissection repair due to poor recovery of cardiac function and died during the hospital stay, and the other five patients had successful PCI, underwent aortic dissection repair, and remained alive at 5 year follow-up. In conclusion, LMCA malperfusion caused by AAAD seemed to have clinical presentations and electrocardiogram changes similar to acute coronary syndrome. PCI and subsequent surgical aortic repair saved the lives of all AAAD patients with LMCA malperfusion who had not required VA-ECMO.
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Affiliation(s)
- Yuya Taguchi
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, 710-8602, Japan.
| | - Shunsuke Kubo
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, 710-8602, Japan
| | - Akihiro Ikuta
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, 710-8602, Japan
| | - Kohei Osakada
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, 710-8602, Japan
| | - Makoto Takamatsu
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, 710-8602, Japan
| | - Kotaro Takahashi
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, 710-8602, Japan
| | - Masanobu Ohya
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, 710-8602, Japan
| | - Takenobu Shimada
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, 710-8602, Japan
| | - Katsuya Miura
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, 710-8602, Japan
| | - Ryosuke Murai
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, 710-8602, Japan
| | - Takeshi Tada
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, 710-8602, Japan
| | - Hiroyuki Tanaka
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, 710-8602, Japan
| | - Yasushi Fuku
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, 710-8602, Japan
| | - Tsuyoshi Goto
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, 710-8602, Japan
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, Japan
| | - Kazushige Kadota
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, 710-8602, Japan
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21
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Cho T, Uchida K, Yasuda S, Matsuzawa Y, Kobayashi Y. Early coronary reperfusion using only guidewires for acute type A aortic dissection. Gen Thorac Cardiovasc Surg 2021; 69:1344-1346. [PMID: 34086151 DOI: 10.1007/s11748-021-01662-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/01/2021] [Indexed: 11/30/2022]
Abstract
Coronary malperfusion with acute type A aortic dissection is a fatal complication. It is controversial whether to prioritize central repair or coronary reperfusion. Lifesaving becomes even more difficult if a patient has pericardial haemorrhage. Herein, we report a case of acute type A aortic dissection associated with left coronary malperfusion and pericardial haemorrhage, wherein reperfusion of the left coronary artery was performed using only guidewires, and central repair could be performed without major delay. Coronary reperfusion using only guidewires can be a revolutionary therapeutic strategy for this disease.
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Affiliation(s)
- Tomoki Cho
- Cardiovascular Center, Yokohama City University Medical Center, 232-0024 4-57 Urafunecho, Minamiku, Yokohama, Japan.
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center, 232-0024 4-57 Urafunecho, Minamiku, Yokohama, Japan
| | - Shota Yasuda
- Cardiovascular Center, Yokohama City University Medical Center, 232-0024 4-57 Urafunecho, Minamiku, Yokohama, Japan
| | - Yasushi Matsuzawa
- Cardiovascular Center, Yokohama City University Medical Center, 232-0024 4-57 Urafunecho, Minamiku, Yokohama, Japan
| | - Yoshiyuki Kobayashi
- Cardiovascular Center, Yokohama City University Medical Center, 232-0024 4-57 Urafunecho, Minamiku, Yokohama, Japan
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22
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Utility of ECG-Gated CTA for Detecting and Classifying Coronary Artery Involvement in Patients With Type A Aortic Dissection and Sinus of Valsalva Involvement. AJR Am J Roentgenol 2021; 217:1334-1343. [PMID: 34008997 DOI: 10.2214/ajr.21.25744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Extension of type A aortic dissection (TAAD) from the sinus of Valsalva (SV) into the coronary arteries is associated with worse prognosis and requires direct coronary repair or coronary artery bypass graft (CABG) depending on extent of involvement. Objectives: To assess the diagnostic performance of ECG-gated aortic CTA for detection and classification of coronary artery involvement in patients with TAAD involving the SV, using surgical findings as reference. Methods: This retrospective study included 112 patients who underwent preoperative ECG-gated aortic CTA demonstrating TAAD with SV involvement. Two radiologists independently reviewed CTA images for right coronary artery (RCA) and left coronary artery (LCA) involvement. Involvement was classified using a previously described system as type A (coronary ostial dissection), B (dissection with coronary false channel), or C (complete detachment from aortic root with dissection encircling the coronary artery). Diagnostic performance of CTA was calculated using surgical findings as reference, interreader agreement was assessed, and surgical interventions were summarized. Results: At surgery, the RCA was uninvolved in 33 patients and exhibited type A, B, and C involvement in 45, 19, and 15 patients, respectively; the LCA was uninvolved in 70 patients and exhibited type A, B, and C involvement in 34, 8, and 0 patients, respectively. For the two readers, sensitivity in RCA, was 86.7%-91.1% for type A, 79.0%-89.5% for type B, 86.7%-93.3% for type C, and 97.5%-98.7% for any involvement. Sensitivity in LCA was 85.3%-91.2% for type A, 87.5%-100.0% for type B, and 100.0%-100.0% for any involvement. Specificity was, in RCA, 94.0%-97.0% for type A, 95.7%-96.7% for type B, 96.9%-96.9% for type C, and 93.9%-97.0% for any involvement. Specificity was, in the LCA, 96.2%-98.7% for type A, 96.2%-97.1% for type B, and 97.1%-98.6% for any involvement. Interreader agreement for types of involvement ranged from kappa=0.85-0.96. Most common intervention was aortic repair for SV involvement alone (55.7%-63.6%), coronary artery repair for types A and B (53.3%-87.5%), and CABG for type C (86.7%). Conclusions: ECG-gated CTA has high diagnostic performance for detecting and classifying coronary involvement from TAAD with SV involvement. Clinical Impact: CTA findings may help guide presurgical planning in these patients.
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23
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Lu Z, Xue Y, Fan F, Cao H, Pan J, Zhou Q, Wang D. Malperfusion syndromes in acute type A aortic dissection do not affect long-term survival in Chinese population: A 10-year institutional experience. J Card Surg 2021; 36:1943-1952. [PMID: 33870559 DOI: 10.1111/jocs.15464] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/29/2021] [Accepted: 02/17/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Preoperative malperfusion of acute type A aortic dissection (ATAAD) remains a catastrophic complication that is associated with high postoperative morbidity and mortality. The relationship between malperfusion and long-term survival in the Chinese population is unknown. METHODS A total of 771 patients who underwent ATAAD surgery between January 2009 and December 2018 at our center were included. In-hospital mortality, complications, morbidity, and long-term survival were analyzed. RESULTS Preoperative malperfusion was identified in 292 of 771 patients (37.9%), the in-hospital mortality rate was 20.9% in patients with preoperative malperfusion and 9.2% in those without. Independent predictors of in-hospital mortality included any malperfusion (odds ratio [OR], 5.132; p = .001), pericardial tamponade (OR, 1.808; p = .046), advanced age (OR, 1.028; p = .003), and cardiopulmonary bypass time (OR, 1.008; p = .001). Immediate emergency surgery (OR, 0.492; p = .007) and antegrade cerebral perfusion perioperatively (OR, 0.477; p = .020) were protective against postoperative mortality. The postoperative survival rates at 1, 3, and 5 years were 94.4% ± 1.5%, 91.9% ± 1.8%, and 83.0% ± 3.2% in patients with malperfusion and 94.7% ± 1.1%, 90.2% ± 1.7%, and 84.4% ± 2.7%, respectively, in those without. Preoperative malperfusion did not significantly affect the long-term outcomes of operative survivors (log-rank p = .601). CONCLUSION Malperfusion resulted in an unfavorable prognosis in the short term, but showed almost equal long-term survival in patients without malperfusion of ATAAD. Emergency central repair might be considered to further improve the outcomes of ATAAD with malperfusion.
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Affiliation(s)
- Zirun Lu
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China.,Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Yunxing Xue
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Fudong Fan
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Hailong Cao
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Jun Pan
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Qing Zhou
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Dongjin Wang
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China.,Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
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24
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Cho T, Uchida K, Kasama K, Machida D, Minami T, Yasuda S, Matsuki Y, Suzuki S, Masuda M. Brachiocephalic artery dissection is a marker of stroke after acute type A aortic dissection repair. J Card Surg 2021; 36:902-908. [PMID: 33442891 DOI: 10.1111/jocs.15322] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/16/2020] [Accepted: 12/18/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Postoperative stroke is a serious unsolved complication after acute type A aortic dissection (ATAAD) repair. We investigated the incidence and risk factors of stroke, and hypothesized that dissection of supra-aortic vessels is an important risk factor of this morbidity. METHODS Between 2012 and 2019, 202 (56% men, median age 68 years) patients with ATAAD underwent surgical repair. Clinical data, image findings, method of circulatory support, and repair technique were retrospectively investigated to explore the risk factor of postoperative stroke. RESULTS Of the 202 patients, operative mortality was 6% and the incidence of postoperative stroke was 12% (n = 25). Brachiocephalic artery (BCA) dissection was associated with a higher risk of stroke (odds ratio, 3.89; 95% confidence interval, 1.104-13.780; p = .035) having no relation to the presence or absence of left common carotid artery dissection. Preoperative malperfusion syndrome, circulatory arrest time, isolated cerebral perfusion time, repair technique (total arch replacement), and femoral artery perfusion alone were not related to the incident rate of postoperative stroke. Stroke occurred in both hemispheres, regardless of the laterality of carotid artery dissection. CONCLUSION BCA dissection was an independent risk factor of stroke after ATAAD repair.
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Affiliation(s)
- Tomoki Cho
- Department of Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Keiji Uchida
- Department of Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Keiichiro Kasama
- Department of Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Daisuke Machida
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Tomoyuki Minami
- Department of Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Shota Yasuda
- Department of Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
| | | | - Shinichi Suzuki
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Munetaka Masuda
- Department of Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan.,Department of Surgery, Yokohama City University, Yokohama, Japan
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25
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Yamaguchi T, Nakai M, Sumita Y, Miyamoto Y, Matsuda H, Inoue Y, Yoshino H, Okita Y, Minatoya K, Ueda Y, Ogino H. Impact of structural and process quality indicators on the outcomes of acute aortic dissection. Eur J Cardiothorac Surg 2020; 58:1281-1288. [PMID: 32864688 DOI: 10.1093/ejcts/ezaa266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/15/2020] [Accepted: 06/11/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The mortality of acute aortic dissection (AAD) remains high, and evidence-to-practice gaps exist in real-world treatment. We explored the first quality indicators (QIs) for AAD management and evaluated the associations between the achievement of these QIs and the outcome in a nationwide administrative database. METHODS A systematic search was performed to establish initial index items for QIs. An evaluation was performed through an expert consensus meeting using the Delphi method. We studied 18 348 patients who had AAD (type A: 10 131; type B: 8217) in the Japanese Registry of All Cardiac and Vascular Diseases database between April 2012 and May 2015. The associations between the achievement of QIs [categorized into tertiles (low, middle and high)] and in-hospital mortality were determined by multivariable mixed logistic regression analyses. RESULTS AND CONCLUSION We developed a total of 9 QIs (5 structural and 4 process). Lower achievement rates of QIs were significantly associated with higher in-hospital mortality in both types [type A = middle: odds ratio (OR) 4.03; 95% confidence interval (CI) 3.301-4.90; P < 0.001; low: OR 15.68; 95% CI 11.67-21.06; P < 0.001 vs high; type B = middle: OR 3.48; 95% CI 2.19-5.53; P < 0.001; low: OR 7.79; 95% CI 4.65-13.06; P < 0.001 vs high]. Various sensitivity analyses showed consistent results. High achievement rates of QIs were significantly associated with reduced in-hospital mortality. Evaluating each hospital's management using QIs would help to equalize treatment quality and demonstrate the evidence-to-practice gaps in real-world treatments for AAD.
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Affiliation(s)
- Tetsuo Yamaguchi
- Department of Cardiovascular Center, Toranomon Hospital, Tokyo, Japan
| | - Michikazu Nakai
- Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yoko Sumita
- Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yoshihiro Miyamoto
- Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yousuke Inoue
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hideaki Yoshino
- Department of Cardiology, Kyorin University Graduate School of Medicine, Tokyo, Japan
| | - Yutaka Okita
- Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuichi Ueda
- Department of Cardiology, Nara Prefecture General Medical Center, Nara, Japan
| | - Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
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26
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Acute Type A Aortic Dissection With Cardiopulmonary Arrest at Presentation. Ann Thorac Surg 2020; 112:1210-1216. [PMID: 33271116 DOI: 10.1016/j.athoracsur.2020.11.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 10/23/2020] [Accepted: 11/09/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Management of acute type A aortic dissection (AADA) presenting with cardiopulmonary arrest (CPA) may require aggressive cardiopulmonary resuscitation (CPR), including extracorporeal CPR followed by aortic repair. This study evaluated the early and long-term outcomes of patients with preoperative CPA related to AADA. METHODS Between September 2003 and August 2019, 474 patients with AADA were brought to our hospital, 157 (33.1%) presenting with CPA. Their mean age was 74.3 ± 11.3 years and prevalence of out-of-hospital CPA 90%, and causes of CPA were cardiac tamponade in 75%, hemothorax in 10%, and coronary malperfusion in 10% of cases. In the same time periods 2974 patients with CPA were transported, and AADA was 4.8% of all cause of CPA. RESULTS Return of spontaneous circulation was achieved in 26 patients (17%) and extracorporeal CPR was required in 31 (20%); 131 CPA patients (83%) died before surgery, 24 (15%) underwent aortic repair, and 2 (1%) received nonsurgical care. Hospital mortality was 90%, and none survived without aortic repair. Of patients achieving return of spontaneous circulation 17 underwent aortic repair, 13 survived, and 5 fully recovered. All patients with extracorporeal CPR died: 24 before surgery and 7 postoperatively. There were significant differences in hospital mortality between patients who did and did not undergo aortic repair (P < .01). Aortic repair was the only significant predictor of long-term survival (P < .01). CONCLUSIONS AADA with CPA is associated with significantly high mortality; however aortic repair can be performed with a 30% likelihood of functional recovery, if return of spontaneous circulation is achieved. Preoperative extracorporeal membrane oxygenation is not recommended in this patient cohort.
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Yamamoto S, Ogawa T, Hayashida T, Kato G, Shichijo T. Temporary stenting in a case of Stanford type A aortic dissection complicated with left main coronary ischemia. Gen Thorac Cardiovasc Surg 2020; 69:100-102. [PMID: 32430747 DOI: 10.1007/s11748-020-01385-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/05/2020] [Indexed: 11/25/2022]
Abstract
A 54-year old man suffering from back pain was diagnosed with Stanford type A aortic dissection in our emergency unit. During the preparation of the operating room, he developed coronary ischemia with chest pain and depressed blood pressure accompanied with abnormal electro- and echocardiography findings. He was transported to the catheter laboratory where stent placement into the left main coronary artery was successfully performed. Thereafter, he underwent total arch replacement, during which the stent was removed intentionally without performing coronary artery bypass graft. His postoperative course was uneventful and he is doing well without any ischemic event for 2 years after the surgery.
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Affiliation(s)
- Shu Yamamoto
- Department of Cardiovascular Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahimachi, Takamatsu, Kagawa, 760-8557, Japan.
| | - Tatsuya Ogawa
- Department of Cardiovascular Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahimachi, Takamatsu, Kagawa, 760-8557, Japan
| | - Tomohiro Hayashida
- Department of Cardiovascular Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahimachi, Takamatsu, Kagawa, 760-8557, Japan
| | - Gentaro Kato
- Department of Cardiovascular Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahimachi, Takamatsu, Kagawa, 760-8557, Japan
| | - Takeshi Shichijo
- Department of Cardiovascular Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahimachi, Takamatsu, Kagawa, 760-8557, Japan
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28
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Boldyrev SY, Suslova VN, Pekhterev VA, Barbukhatti KO, Porkhanov VA. [Complete detachment of the right coronary artery in a patient with acute aortic dissection type A]. Khirurgiia (Mosk) 2020:74-76. [PMID: 32352673 DOI: 10.17116/hirurgia202004174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Extremely rare and formidable complication of acute aortic dissection type A in a young patient is reported in the article. Clinical symptoms and features of surgical technique are described.
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Affiliation(s)
- S Yu Boldyrev
- Research Institute - Ochapovsky Regional Clinic Hospital No. 1 of the Ministry of Health of Krasnodar Region, Krasnodar, Russia.,Kuban State Medical University of the Ministry of Health of Russia, Department of Cardiac Surgery and Cardiology, Advanced Training Faculty, Krasnodar, Russia
| | - V N Suslova
- Kuban State Medical University of the Ministry of Health of Russia, Department of Cardiac Surgery and Cardiology, Advanced Training Faculty, Krasnodar, Russia
| | - V A Pekhterev
- Research Institute - Ochapovsky Regional Clinic Hospital No. 1 of the Ministry of Health of Krasnodar Region, Krasnodar, Russia
| | - K O Barbukhatti
- Research Institute - Ochapovsky Regional Clinic Hospital No. 1 of the Ministry of Health of Krasnodar Region, Krasnodar, Russia.,Kuban State Medical University of the Ministry of Health of Russia, Department of Cardiac Surgery and Cardiology, Advanced Training Faculty, Krasnodar, Russia
| | - V A Porkhanov
- Research Institute - Ochapovsky Regional Clinic Hospital No. 1 of the Ministry of Health of Krasnodar Region, Krasnodar, Russia
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Norton EL, Khaja MS, Williams DM, Yang B. Type A aortic dissection complicated by malperfusion syndrome. Curr Opin Cardiol 2020; 34:610-615. [PMID: 31397690 DOI: 10.1097/hco.0000000000000667] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Malperfusion is present in up to 40% of acute type A aortic dissections (ATAADs) and results in increased morbidity and mortality. This review presents different management strategies in patients with ATAAD and malperfusion to improve outcomes. RECENT FINDINGS While the ideal management strategy of ATAAD complicated by malperfusion has yet to be determined, the literature provides evidence for additional techniques to be used in conjunction with central aortic repair to reduce mortality. SUMMARY Recent findings support a role for initial reperfusion and delayed central aortic repair, although optimal management strategy remains debated.
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Affiliation(s)
| | | | | | - Bo Yang
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
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